CSE's Press Release: Dialogue on Air Pollution and our health

Doctors warn: We need to act fast to breathe easy

Noted doctors, health researchers and air quality regulators met in the capital today to warn that cities may wake up to more wheeze and other ailments if health concerns are not heeded for air pollution control.

Dialogue exposed mounting evidences on health effect of air pollution in India and abroad that must drive policy action.

CSE review shows most studies in India have been done by doctors; they have tracked newer health risk of newer air quality challenges.

Air quality regulators must take note of these findings and immediately set the post 2010 emissions standards for vehicles to cut emissions at source; upgrade public transport, and restrain cars.

New Delhi, August 31, 2011: All of us who travel on urban roads regularly and those who live close to roads, are at a serious health risk from vehicular air pollution. And according to estimates, about 55 per cent of Delhi’s population lives within 500 metre from such roads – and is therefore, prone to a variety of physical disorders.

This was one of the key arguments put forth at a Dialogue between doctors, air quality regulators and civil society representatives, organised here today by Centre for Science and Environment (CSE), in association with the Indian Council for Medical Research (ICMR) and the Indian Medical Association (IMA).

Participants in the Dialogue included the secretary, Department of Health Research; director general, ICMR; secretary, Union ministry of environment and forests; members of the IMA; international health experts; members of the Supreme Court’s Environment Pollution (Prevention and Control) Authority (EPCA); and doctors from key facilities such as All India Institute of Medical Sciences, Sitaram Bhartia Institute of Sciences and Research, Vallabhbhai Patel Chest Institute, Chest Research Foundation (Pune), Heart Care Foundation, and the Post Graduate Institute of Medical Education & Research (Chandigarh).

The participants in the Dialogue made a strong plea for integration of health information into decision-making on air pollution control.

Stunning evidences
The Dialogue brought to light new dramatic evidences of how much we inhale while traveling in Delhi. Researchers from the University of California, Berkeley, have traveled in auto-rickshaws during the months of February and May 2010, on a fixed route in south Delhi. They measured the actual particle concentration inside the vehicle while moving with the traffic – and found that commuters breathe far more harmful particles inside vehicles while traveling compared to the ambient concentration. The PM2.5 concentrations inside vehicles can be 1.5 times higher than the surrounding background air; ultra-fine levels are about 8.5 times higher.

CSE review of health studies on air pollution, and what it has found

New studies, new evidences: Over the last two decades, consistent efforts have been made in Indian cities to assess the health impacts of air pollution. The mega cities, most polluted during the 80s-90s took the lead to study health effects, though studies are also going on in other cities such as Bikaner, Amritsar, Varanasi, Puducherry, Mandi-Gobindgarh and Kanpur.

Doctors drove these studies: 53 per cent of the studies in India have been carried out by doctors themselves, who understand our health and whose evidences can help change policies.

Looking beyond lungs to other health effects: Studies are dominated by the focus on respiratory symptoms. But in the recent years, more diverse health end points – cardiac cases, cancer, mutagenic effects, etc have been taken into account. Though this investigation in India is still nascent, global studies have shown more robust linkages with a wide range of health endpoints – diabetes, stroke, hyper tension, effects on brain, effects on fetus etc.

Children and air pollution: Children are especially vulnerable to urban air pollution. A 2010 study of Chittaranjan National Cancer Research Institute (CNCI) shows respiratory symptoms in 32% of children examined in Delhi, in contrast to only 18.2% of the rural children. Lung function is reduced in 43.5% school children in Delhi. Attention-deficit hyperactivity disorder (ADHD) has been noticed in children chronically exposed to high level of vehicular pollution (CNCI 2010). PM10 was positively and strongly associated with ADHD prevalence. Air pollution even affects vitamin D status of infants and toddlers in Delhi (2002).

Serious concern over growing burden of non-communicable diseases in India and environmental health risks: According to the recent estimates from the World Bank, non-communicable diseases(NCD) impose the largest health burden in India. In terms of the number of lives lost due to ill-health, disability, and early death, NCDs accounts for 62% of the total disease burden. Cardiovascular diseases, cancer, respiratory diseases, and diabetes are the major NCDs in India. A range of factors including genetic, and lifestyle may contribute but as a public policy the role of the environmental risks should be minimised.

Globally, studies are being carried out to understand the link between non-communicable diseases and air pollution. Toxic PAH is also known to affect the fetus. India needs to strengthen this line of enquiry.

Worries about growing toxic risk: Given the fact that endpoint of all toxic risk is cancer, all environmental risk factors should be minimized. India reports more than 700,000 new cancer cases and National Cancer Control Programme (NCCP) forecasts that by 2026, more than 1.4 million people will be falling in the grip of the disease. NCCP has listed greater exposure to environmental carcinogens as one of the most important reasons. Though there is not one factor – air pollution is one of the important one.

India is motorising at a level that can compound health risks, due to technology and low fuel quality. There are special concerns about growing use of poor quality diesel. Diesel exhaust includes a large number of toxic compounds that cause cancer, reproductive abnormalities and other toxic impacts.

More interest in how much we inhale. Researchers are looking not just at the effect of the ambient air quality – which is the quality of the surrounding air – but at the actual exposure – how much we inhale in proximity to a source like traffic.

Such evidences have serious implications for the road users, public transport users, walkers and cyclists.

Special concern over traffic pollution: Cities have many sources of outdoor air pollution and all require mitigation action. In the future cities will witness rapid increase in vehicular traffic. Vehicular emissions contribute to significant human exposure. Pollution concentration in our breathe is 3-4 times higher than the ambient air concentration.

International agencies have tracked the effect of polluted air on illnesses and premature deaths in Indian cities. The US based Health Effect Institute study in Delhi estimates approx.0.15% to 0.17% increase in mortality per 10 μg/m3 PM10 (~0.3%/ 20 μg/m3). In Delhi where overall deaths are 100,000 annually even this increase can translate into 3000 additional premature deaths annually due to air pollution related diseases.

Studies of massive scale carried out in other parts of the world prove beyond doubt that air pollution has definite and insidious health effects: Studies of this nature and scale have not been possible in India yet.

Act now to reduce exposure and toxic risk

India cannot afford to ignore the ominous evidences any more. We will have to take action now to reverse the trend of short term as well as the long term toxic effects.

Stringency and pace of action should be guided by the health risks consideration. The ongoing preparation for the 12th five year plan, expansion of the air quality monitoring programme, city initiatives on clean air action plans, framing of the post-2010 emissions regulations for vehicles are the opportunities to integrate health criteria to make air quality management more relevant to public health.

Set targets to meet air quality standards in cities: Enforce National Ambient Air Quality Standards. The central assistance to states for implementation of the city action plan for clean air should be linked with the implementation of pollution control measures. For this verifiable benchmark and monitoring system should be developed.

Strategy for vehicular pollution control: It is unacceptable that while health risks are increasing the post 2010 emissions standards roadmap for vehicles have not been decided yet. The phase in of tighter emissions standards of Euro V/VI nationwide by the end of 12 five year period needs to be brought about. Ultra-low sulphur diesel along with advanced emissions control technologies should be implemented nation-wide. Simultaneously improve public transport, promote walking and cycling, and reduce dependence on cars.

Account for the health cost in decision making: A better valuation of acute and chronic illnesses linked to air pollution needs to be carried out in India and integrated with decision making. There should be more support to initiate health studies on air pollution.

Need strong baseline data on diseases and deaths as well as robust protocol to support health risk assessment: Air quality monitoring should be well designed to enable such studies.

Build public information system on daily air quality with health advisories: Globally, governments have developed air quality index to inform people about the daily air quality through easily understood air quality bands and issue health advisories for those who are especially those who are vulnerable to air pollution. Some governments even frame pollution emergency measures to reduce the pollution peaks to more tolerable level.